The foundation of an acute stroke research program is an acute stroke clinical service that will assure maximum patient referral and allow rapid identification, screening and recruitment of potential research subjects in the timely fashion needed to study the early events in cerebral injury and enroll patients in acute stroke research protocols. Absence of an emergency department and the time constraints on screening and recruitment of acute stroke patients as research subjects has precluded the NIH Clinical Center as the main site of our research projects. Thus, we have established and maintained the clinical, imaging and research infrastructure required to support such a program at local hospitals, Suburban Hospital (SH) in Bethesda, Maryland, and MedStar Washington Hospital Center (MWHC) in DC. These sites also serve as the key training locations for our ACGME accredited vascular neurology fellowship training program and for recruitment into the traumatic brain injury research protocols. The major elements of this infrastructure include the NIH Stroke Service, a combination of NIH and contractor clinicians stroke neurologists, nurses, clinical fellows, on-site research/nurse coordinators and MRI technologists. The NIH computer network has been extended to each site. In addition NIH has placed a 3T MRI scanner at MWHC and shares a 3T MRI scanner at SH. We maintain our own PACS for images obtained on the MWHC and SH MRI scanners, and developed and maintain a registry for clinical and research patient data. In the past year we screened approximately 1150 patients with suspected stroke and enrolled approximately 170 patients into one of our clinical research protocols.